Health and Human Services Secretary Sylvia Mathews Burwell said that when the agency Wednesday releases its final report under her watch on marketplace enrollment, the figures will show “a marketplace that millions of folks have come to” rather than a system on a downward trajectory.
However, if Republicans repeal the 2010 health care law without creating an alternative, Burwell told reporters Tuesday that “it is fair to say it puts the marketplace in that kind of negative spiral, in a death spiral.”
She then backed away from the “death spiral” description, saying she prefers to focus on facts rather than a catchphrase. She pointed to a new analysis from the Congressional Budget Office that projects that a GOP bill to repeal the health care law would increase the number of individuals without insurance by 18 million in just the first year following enactment. Premiums for plans purchased in the individual marketplace would increase by up to 25 percent in that year, CBO found.
The lower enrollment and higher prices would occur regardless of whether the repeal took effect immediately or was delayed for a period of time, Burwell said, because some consumers and insurers would abandon the marketplace.
“Repeal and delayed replacement is repeal,” Burwell said.
Burwell herself expects to sign up for marketplace coverage in the District of Columbia after she leaves her position on Friday. She expects to take some time to travel, read and consider her future plans. She noted that the health care law’s provision banning insurers from excluding coverage of pre-existing conditions helps her personally because her husband is a skin cancer survivor.
She raised questions about whether Republicans really plan to keep those protections in their entirety, which would be costly if Republicans follow through on plans to eliminate penalties for people who don’t buy insurance. Several Republicans have suggested loosening the provision affecting pre-existing conditions so that insurers could charge consumers more for coverage of medical problems if individuals dropped their coverage for a while.
Burwell said that the execution of policies in the Trump administration could be as important as any revisions to Obama administration initiatives.
However, she did note that eliminating subsidies that help the lowest-income people on the exchanges with the costs of their copays and deductibles would have a significant impact. The Obama administration has been defending the cost-sharing subsidies in a lawsuit, but the Trump administration could drop that effort, effectively eliminating the subsidies.
If that happens, said Burwell, “you’ve gone straight against affordability for millions of people.”
Burwell’s comments came during a final meeting with reporters in the administration’s final days.
She acknowledged that it would be difficult for the agency to approve the expansion of Medicaid in North Carolina, the last state to request it. The action has been stymied by court action. Even if the court permits HHS to accept the expansion request, time is short. “It would depend on the timing,” Burwell said.